Total Hip Arthroplasty for the Sequelae of Femoral Neck Fractures in the Pediatric Patient.
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SUBMITTER: Fassihi SC
PROVIDER: S-EPMC7264979 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:OBJECTIVES:To determine if hospital arthroplasty volume affects patient outcomes after undergoing total hip arthroplasty (THA) for displaced femoral neck fractures. METHODS:The Statewide Planning and Research Cooperative System database from the New York State Department of Health was used to group hospitals into quartiles based on overall THA volume from 2000 to 2010. The database was then queried to identify all patients undergoing THA specifically for femoral neck fracture during this time period. The data were analyzed to investigate outcomes between the 4 volume quartiles in 30-day and 1-year mortality, 1-year revision rate, and 90-day complication rate (readmission for dislocation, deep vein thrombosis, pulmonary embolism, prosthetic joint infection, or other complications related to arthroplasty in the treatment of femoral neck fractures with THA). RESULTS:Patients undergoing THA for femoral neck fracture at hospitals in the top volume quartile had significantly lower 30-day (0.9%) and 1-year (7.51%) mortality than all other volume quartiles. There were no significant differences on pairwise comparisons between the second, third, and fourth quartiles with regard to postoperative mortality. There was no significant difference in revision arthroplasty at 1 year between any of the volume quartiles. On Cox regression analysis, THA for fracture at the lowest volume (fourth) quartile [hazard ratio (HR), 1.91; P = 0.016, 95% confidence interval (CI), (1.13-3.25)], second lowest volume (third) quartile (HR, 2.01; P = 0.013, 95% CI, 1.16-3.5) and third lowest volume (second) quartile (HR, 2.13; P = 0.005, 95% CI, 1.26-3.62) were associated with increased risk for a 1-year postoperative mortality event. Hospital volume quartile was also a significant risk factor for increased 90-day complication (pulmonary embolism/deep vein thrombosis, acute dislocation, prosthetic joint infection) following THA for femoral neck fracture. Having surgery in the fourth quartile (HR, 2.71; P < 0.001, 95% CI, 1.7-4.31), third quartile (HR, 2.61; P < 0.001, 95% CI, 1.61-4.23), and second quartile (HR, 2.41; P < 0.001, 95% CI, 1.51-3.84), all were significant risk factors for increased 90-day complication risk. CONCLUSIONS:The results of this population-based study indicate that THA for femoral neck fractures at high-volume arthroplasty centers is associated with lower mortality and 90-day complication rates but does not influence 1-year revision rate. THA for femoral neck fractures at top arthroplasty volume quartile hospitals are performed on healthier patients more quickly. Patient health is a critical factor that influences mortality outcomes following THA for femoral neck fractures. LEVEL OF EVIDENCE:Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
| S-EPMC5111872 | biostudies-literature
Project description:IntroductionRecent clinical evidence suggests that total hip arthroplasty (THA) provides improved clinical outcomes as compared to hemiarthroplasty (HA) for displaced femoral neck fractures in elderly individuals. However, THA is still utilized relatively infrequently. Few studies have evaluated the factors affecting utilization and the role socioeconomics plays in THA versus HA.MethodsIn the United States, the National Inpatient Sample (NIS) database was used to identify patients treated surgically for femoral neck fracture, between 2009 and 2010. Patients were identified using International Classification of Diseases, Ninth Revision, codes for closed, transcervical femoral neck fractures and closed fractures at unspecified parts of the femoral neck. All candidate predictors of THA versus HA were entered into a multilevel mixed-effect regression model.ResultsOlder patient age, being Asian or Pacific Islander, and having Medicaid payer status were all associated with lower odds of receiving THA. Patients with private insurance including Health Maintenance organization (HMO) had higher odds of THA as did patients with other insurance. Odds of THA were significantly lower among patients in teaching hospitals and higher at hospitals with greater THA volume.DiscussionEthnicity, payer status, hospital size, and institutional THA volume were all associated with the utilization of THA versus HA in the treatment of geriatric femoral neck fractures.Level of evidenceLevel III Retrospective Cohort study.
| S-EPMC5557198 | biostudies-literature
Project description:BACKGROUND: Most patients with displaced femoral neck fractures are treated by THA and hemiarthroplasty, but it remains uncertain which if either is associated with better function and lower risks of complications. QUESTIONS/PURPOSES: We performed a meta-analysis of randomized controlled trials (RCTs) to determine whether THA was associated with lower rates of reoperations, mortality, complications, and better function compared with hemiarthroplasty. METHODS: We searched the PubMed, Embase, Chinese Biomedicine Literature, and Cochrane Register of Controlled Trials databases and identified 12 RCTs (including a total of 1320 patients) for meta-analysis. Risk ratios (RRs) and weighted mean differences (WMDs) from each trial were pooled using random-effects or fixed-effects models depending on the heterogeneity of the included studies. RESULTS: THA was associated with a lower risk of subsequent reoperations compared with hemiarthroplasty (RR = 0.53; 95% CI, 0.34-0.84). There was no difference in mortality between patients undergoing THA and hemiarthroplasty (RR = 0.81; 95% CI, 0.60-1.09). For complications, there was a higher risk of dislocation in patients undergoing THA (RR = 1.99; 95% CI, 1.26-3.15), but there were no differences in local infections (RR = 1.60; 95% CI, 0.74-3.46) and general complications (RR = 1.15; 95% CI, 0.91-1.45). Patients with THA had higher Harris hip scores at 1 year (WMD = 3.81; 95% CI, 0.87-6.74) and at 3 or 4 years (WMD = 10.07; 95% CI, 6.92-13.21). CONCLUSIONS: Despite more dislocations, THA can benefit patients with displaced femoral neck fractures with a lower reoperation rate and higher functional scores.
| S-EPMC3392403 | biostudies-literature
Project description:Background:Total hip arthroplasty (THA) is the preferred treatment for displaced femoral neck fractures in select patients, although dislocation remains a concern. In some studies, the supercapsular percutaneously assisted (SuperPATH) approach has demonstrated early mobilization, short hospital stay, and low dislocation rates in primary THA, but there are little data on its use for fractures. This study describes the perioperative outcomes and early dislocation rate of SuperPATH THA for displaced femoral neck fragility fractures. Methods:A retrospective review was performed of previous ambulatory patients with a displaced femoral neck fragility fracture treated with THA using the SuperPATH approach. Demographic data, time to ambulation, length of stay, and in-hospital complications during the hospital stay and follow-up period were recorded. Phone interviews were conducted to check for dislocations 1 year after surgery. Results:Thirty-seven consecutive patients were included with an average age of 75.0 years. Hospital stay averaged 5.5 days, and patients were discharged on average postoperative day 3.6. About 83.8% of patients were ambulatory by postoperative day 1, and 94.6% ambulatory before discharge. Twenty-seven percent of patients were discharged home, 46% to inpatient rehabilitation, 24% to skilled nursing facility, and 1 patient to hospice. At follow-up, there was no symptomatic heterotopic ossification and no infections. Thirty-two patients were available for telephone interviews at 1 year, with no dislocations reported. Conclusions:In this small cohort, the SuperPATH approach for THA appears to be safe and effective for use in femoral neck fragility fractures, resulting in early ambulation and a low dislocation rate.
| S-EPMC6588679 | biostudies-other
Project description:BackgroundHip replacement is divided into total hip arthroplasty (THA) and hemiarthroplasty (HA); it is still controversial whether to choose THA or HA for femoral neck fractures (FNF). The goal of this study was to review relevant studies in order to determine the HA compared to THA for the treatment of FNF.Patients and methodsUsing appropriate keywords, we identified relevant studies using PubMed, Cochrane, and Embase. Key pertinent sources in the literature were also reviewed, and all articles published through August 2019 were considered for inclusion. For each study, we assessed odds ratios (ORs), mean difference (MD), and 95% confidence interval (95% CI) to assess and synthesize outcomes.ResultsWe included 19 studies with a total of 413,140 patients in the HA group and 44973 in the THA group. The blood loss, surgery time, and dislocation were all significantly decreased in the HA group than the THA group. The length of hospital, pneumonia, and renal failure were significant increased in the HA group than THA group. There has no significant difference of complication, mortality, reoperation, infection, pulmonary embolism, and myocardial infarct between the two groups.ConclusionHA has favor in decrease blood loss and surgery time. THA has favor in decrease the length of hospital, the incidence of pneumonia and renal failure. For the selection of surgical methods for femoral neck fracture in the elderly, we should consider several aspects, such as the age of the patient, whether there is osteoporosis, the type of femoral neck fracture, the preoperative reduction situation, and the needs of the patient and his family for the postoperative situation.
| S-EPMC7931515 | biostudies-literature
Project description:BackgroundRandomized controlled trials (RCTs) are the most reliable way of evaluating the effect of new treatments by comparing them with previously accepted treatment regimens. The results obtained from an RCT are extrapolated from the study environment to the general health care system. The ability to do so is called external validity. We sought to evaluate the external validity of an RCT comparing the results of total hip arthroplasty with those of hemiarthroplasty for the treatment of displaced femoral neck fractures in patients ≥80 years of age.MethodsThis prospective, single-center cohort study included 183 patients ≥80 years of age who had a displaced femoral neck fracture. All patients were screened according to the inclusion and exclusion criteria for an RCT comparing total hip arthroplasty and hemiarthroplasty. The population for this study consisted of patients who gave their informed consent and were randomized into the RCT (consenting group, 120 patients) as well as those who declined to give their consent to participate (non-consenting group, 63 patients). The outcome measurements were mortality, complications, and patient-reported outcome measures. Follow-up was carried out postoperatively with use of a mailed survey that included patient-reported outcome questionnaires.ResultsWe found a statistically significant and clinically relevant difference between the groups, with the non-consenting group having a higher risk of death compared with the consenting group. (hazard ratio, 4.6; 95% confidence interval, 1.9 to 11.1). No differences were found between the groups in terms of patient-reported outcome measures or surgical complications.ConclusionsThis cohort study indicates a higher mortality rate but comparable hip function and quality of life among eligible non-consenters as compared with eligible consenters when evaluating the external validity of an RCT in patients ≥80 years of age with femoral neck fracture.Level of evidenceTherapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
| S-EPMC6613851 | biostudies-literature
Project description:BackgroundThe choice of primary hemiarthroplasty or total hip arthroplasty in patients ≥80 years of age with a displaced femoral neck fracture has not been adequately studied. As the number of healthy, elderly patients ≥80 years of age is continually increasing, optimizing treatments for improving outcomes and reducing the need for secondary surgery is an important consideration. The aim of the present study was to compare the results of hemiarthroplasty with those of total hip arthroplasty in patients ≥80 years of age.MethodsThis prospective, randomized, single-blinded trial included 120 patients with a mean age of 86 years (range, 80 to 94 years) who had sustained an acute displaced femoral neck fracture <36 hours previously. The patients were randomized to treatment with hemiarthroplasty (n = 60) or total hip arthroplasty (n = 60). The primary end points were hip function and health-related quality of life at 2 years. Secondary end points included hip-related complications and reoperations, mortality, pain in the involved hip, activities of daily living, surgical time, blood loss, and general complications. The patients were reviewed at 3 months and 1 and 2 years.ResultsWe found no differences between the groups in terms of hip function, health-related quality of life, hip-related complications and reoperations, activities of daily living, or pain in the involved hip. Hip function, activities of daily living, and pain in the involved hip deteriorated in both groups compared with pre-fracture values. The ability to regain previous walking function was similar in both groups.ConclusionsWe found no difference in outcomes after treatment with either hemiarthroplasty or total hip arthroplasty in active octogenarians and nonagenarians with a displaced femoral neck fracture up to 2 years after surgery. Hemiarthroplasty is a suitable procedure in the short term for this group of patients.Level of evidenceTherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
| S-EPMC6613852 | biostudies-literature
Project description:A 39-year-old male presented with multiple gunshot wounds and resultant left comminuted femoral head and neck fractures with retained intraarticular bullet fragments. Successful staged reconstruction was performed with initial placement of an antibiotic spacer and subsequent conversion to total hip arthroplasty. Staged reconstruction with an antibiotic spacer and conversion to total hip arthroplasty is a viable treatment approach for a gunshot wound resulting in intraarticular bullet fragments and comminuted femoral head and neck fractures not amenable to open reduction and internal fixation to reduce the risk of periprosthetic joint infection.
| S-EPMC8857266 | biostudies-literature
Project description:A femoral neck fracture (FNF) is a common cause of suffering and premature death in the elderly population. Optimizing the treatment for improved outcome and a reduced need for secondary surgery is important both for the patient and the society. The choice of primary total or hemiarthroplasty in patients over eighty years are controversial. We hypothesized that total hip arthroplasty has an equal or better outcome in patient-reported outcome compared with hemiarthroplasty.A prospective, randomized, single-blinded trial will be conducted. We will include 120 patients, 80 years of age and over with an acute (<36 h) displaced femoral neck fracture. The patients will be randomized in a 1:1 ratio to either total hip arthroplasty or hemiarthroplasty. The primary endpoints are Harris hip Score and EQ-5D. Secondary endpoints include pain measured with visual analogue scale, surgical time, reoperations, complications and radiological measurement of erosion in patients operated with hemiarthroplasty. Follow-up will be performed postoperatively after three months, 1, 2, 4 and 10 years.To our knowledge, this is the first randomized controlled trial comparing total hip arthroplasty and hemiarthroplasty for displaced femoral neck fracture in patients age 80 years and over.Clinicaltrial.gov: NCT02246335.
| S-EPMC4617887 | biostudies-literature
Project description:There are an increasing number of vascular complications after hip replacement, some of which can be life-threatening. However, there are few reports of lower limb ischemic symptoms after undergoing an otherwise uncomplicated classic total hip replacement. We report a patient with low weight who developed postoperative limb ischemia resulting from blood clots caused by insertion of a Hohmann retractor close to small anterior acetabular osteophytes. Ultrasonography and angiography revealed her symptoms to be the result of femoral artery intimal injury with lower extremity arterial thrombosis, which led to pain, numbness, and decreased skin temperature. The patient underwent timely percutaneous intervention with a femoral artery stent, which relieved her symptoms. The discussion reviews femoral artery injury during total hip arthroplasty.
| S-EPMC6287226 | biostudies-literature